下肢深静脉功能不全诊治的实验和临床研究

目的研究治疗不同程度下肢原发性深静脉瓣膜功能不全的有效方法。方法①观察以自体大隐静脉片、自体阔筋膜片和人造血管片作深静脉瓣膜包窄术的效果;②分别采用股或静脉瓣修复加包窄术、股或（和）静脉瓣包窄术、股浅静脉瓣修复和包窄加静脉瓣包窄术、自体带瓣腋静脉段静脉移植外加人造血管环包术、股静脉瓣包窄加静脉外代瓣术、静脉外代瓣术,共治疗１２１例（１３３条患肢）;③以静脉插管造影和彩色多普勒超声检查作为诊断和评估疗效的观察指标。结果①以膨体聚四氟乙烯人造血管片作包窄材料的效果最好;②彩超检查与静脉造影比较准确率为９１８６％;③本组患者平均随访３７８年,治愈率９１７３％。结论治疗下肢深静脉瓣膜功能不全,应根据病情选用不同的手术方法。     

下肢深静脉功能不全诊治的实验与临床研究

目的 寻找下肢深静脉瓣膜包窄术最佳环包材料,了解彩超对深静脉瓣膜功能不全的诊断价值和Ｇｕｏ静脉膜功能。方法 （１）观察３０条实验犬以自体大隐静脉片、自体阔筋膜和人造血管片作深静脉膜包窄术的效果;（２）对７８例彩超与经Ｇｕｏ静脉插管造影结果对比;（３）观察正常人与患者Ｇｕｏ静脉瓣膜血液动力学变化。结果 自体阔筋膜和大隐静脉逐渐挛缩呈纤维化瘢痕增生,而膨胀聚四氟乙烯人造血管的形态和结构无明显变化;彩超     

下肢深静脉瓣膜包窄术环包材料的实验研究

治疗下肢原发性深静脉瓣膜功能不全的瓣膜包窄术，常用的环包材料为自体大隐静脉、自体阔筋膜和人造血管片。为取得更好的疗效，我们对上述３种环包材料分组进行了实验观察。一、材料与方法１．实验动物及分组：取体重２５～３０ｋｇ杂种犬３０只，随机分为３组，自体大隐...     

瓣膜包窄术治疗原发性下肢深静脉瓣膜功能不全47例分析

目的　研究应用股浅静脉瓣膜包窄术治疗下肢深静脉瓣膜功能不全的临床效果 ,总结其手术体会。方法　自体阔筋膜片或人造血管片对 47例下肢深静脉瓣膜功能不全患者施行股浅静脉第一对瓣膜包窄术。结果　 47例手术效果均满意 ,其症状完全或基本消失 ,近期随访无复发。结论　瓣膜包窄术治疗下肢深静脉瓣膜功能不全具有较好的疗效和实用性     

人造血管在股浅静脉瓣膜包瓣术中应用研究

目的 研究人造血在股浅静脉瓣膜包瓣术中应用效果。方法 采用人造血管替代大隐静脉片、阔筋膜作包瓣术的包瓣材料,治疗下肢深静脉瓣膜功能不全性疾病２５例,共２５条肢体。结果 随访６￣２４个月,疗效良好者２３例,占９２％,疗效一般者２例,占８％,总有效率为１００％。结论 人造血管是一种值行推广的包瓣材料。     

股浅静脉第一对瓣膜包窄术治疗原发性下肢深静脉瓣膜功能不全

目的:评估应用股浅静脉第一对瓣膜包窄术治疗原发性下肢深静脉瓣膜功能不全的疗效.方法:对原发性下肢深静脉瓣膜功能不全的55例患才施以股浅静脉第一对瓣膜包窄术,包窄材料选用聚四氟乙烯人造血管.结果:本组病人术后均随访4-14个月,术前临床症状缓争,疗效好,结论:股浅静脉第一对瓣膜包窄术治疗瓣膜轻,中度倒流的原发性下肢深静脉瓣膜功能不全,有坚实的理论基础,并有并发症少,操作简单,疗铲好等优点,值得推广.     

下肢深静脉瓣膜环包术环包材料的研究

目的 探讨下肢深静脉瓣膜环包术最环包材料。方法 将自体大隐静脉，阔筋膜和人造血管片分组环包于犬股静脉上，术后不同时期观察长，宽及厚度变化。结果 自体大隐静脉和阔筋膜逐渐挛缩呈纤维化瘢痕增生，３个月出现显著挛缩，６￣１２个月最显著，而膨体聚四氟乙烯人造血管片的形态和结构无明显变化。结论 以膨体聚四氟乙烯人造血管片作环包材料效果最好。     

自体静脉片瓣膜包窄治疗下肢深静脉倒流性病变

目的 评价自体大隐静脉片作为包窄材料行下肢深静脉瓣膜包窄术的临床应用价值。方法 选择通过静脉造影等特殊检查,确诊为原发性深静脉瓣膜功能不全,倒流3～4级,其倒流程度轻度和中度的67例(69条肢体),作股浅静脉瓣膜包窄术。结果 49条肢体随访3～18个月,效果良好的(41/49)占83.67％;病情好转的(6/49)占12.24％;无效者(1/49)占2.04％;血栓形成(1/49)占 2.04％。结论 本手术操作简便、安全、有效,经本院改进的手术方法,合理选择手术适应证,是取得理想效果的关键,但大隐静脉片作为包窄材料具有一定的局限性。     

彩色多普勒超声观察人工关节置换术后 下肢深静脉血栓形成

目的 探讨彩色多普勒超声在人工关节置换术前后的应用价值。方法121例人工关节置换术患者术前、术后进行彩色多普勒超声检查，观察下肢深静脉通畅情况及瓣膜功能，其中30例行下肢静脉造影检查。结果彩色多普勒超声检出静脉血栓61例，其中近端静脉血栓4例，远端静脉血栓57例。瓣膜功能不全的下肢静脉DVT发生率高于正常静脉。彩色多普勒超声检查与静脉造影结果对照，超声诊断下肢静脉血栓的敏感性为93．8％，特异性为100％，超声对小腿肌肉内的静脉血栓显示率高于静脉造影。结论彩色多普勒超声在人工关节置换术前后评价深静脉瓣膜功能，及时诊断深静脉血栓形成，帮助临床筛选高危病例进行积极预防，具有重要的临床应用价值。     

股浅静脉戴戒术术中彩色多普勒超声的应用体会

目的 研究术中彩色多普勒超声指导股浅静脉戴戒术治疗原发性深静脉瓣膜功能不全疗效。方法 对原发性下肢深静脉瓣膜功能不全的患者63例69条肢体采用股浅静脉戴戒术，术中应用彩色多普勒超声测量静脉返流，瓣环扩大及判定瓣膜的功能．指导最佳环缩位置及程度，并于术中判断瓣环及瓣膜修复情况。结果 全组病例均于术中证实，瓣环环缩适当，瓣膜开闭良好，静脉返流完全控制。结论 术中彩色多普勒超声的应用使股浅静脉戴戒术更精确有效，避免了盲目环缩的位置不当、环缩程度不够、返流控制不完善等弊端。     

自体阔筋膜代袢的研究

腘静脉外肌袢形成术是治疗下肢深静脉严重血液倒流性病变的优选手术之一,但手术还存在一些不足之处,如肌袢长度不够,术后肌袢粘连等。本实验结果说明,自体阔筋膜移植后不发生退行性变化,其顺行性和最大抗拉强度与正常对照相比也未下降,从形态学和材料力学角度阐明了自体阔筋膜袢代替肌腱袢的可行性,为临床应用提供了实验依据。     

Percutaneous transpopliteal venography

The authors advocate percutaneous transpopliteal venography as a new method for evaluating the function of deep venous valves of the lower extremity. At the popliteal fossa, the popliteal vein was punctured and a catheter was inserted cephaladly for venographic study of the valves. By this method, not only the ilio-femoropopliteal vein was clearly visualized, also the competence of the valves in this venous segment may accurately be tested one by one, thus making up the shortcomings of the ascending and descending venography. It was found, through this venography, that even if the highest valve of the superficial femoral vein was competent distal valves in the femoral and popliteal veins may become incompetent resulting in primary valvular incompetence of the deep veins in the lower extremity.     

深静脉瓣膜重建术治疗下肢静脉倒流性疾病

为综合评价切开瓣膜修复术、静脉瓣戴戒术和静脉外肌袢成形术三种深静脉瓣膜重建手术的适应证与疗效，对１９９２年１月～１９９６年６月收治的６２例下肢静脉倒流性疾病患者进行了临床研究。全部患者均有不同程度的浅静脉曲张及下肢酸胀感，其中肿胀３０例，足靴区色素沉着２８例，溃疡１４例。病程为１年～３０年，平均１４．６年。１４例患者采用股浅静脉第１对瓣膜戴戒术，１例患者采用股浅静脉切开瓣膜修复术，４７例患者采用月国静脉外肌袢成形术。术后平均随访２０个月，所有患者症状缓解，１４例溃疡均愈合，无一例复发。结果表明：①戴戒术和瓣膜修补术适用于深静脉瓣膜功能不全倒流Ⅰ级～Ⅱ级；②肌袢成形术适用于深静脉瓣膜功能不全倒流Ⅲ级～Ⅳ级或先天性瓣膜功能缺陷；③戴戒材料宽度应增加到２ｃｍ；④对双股静脉畸形的原发性深静脉瓣膜功能不全，应同时行双股浅静脉第１对瓣膜戴戒术。认为，对月国静脉分支较多者仍可施行月国静脉外肌袢成形术，只要术中仔细操作，同样可取得优良效果     

Anatomie des epifaszialen Venensystems

The superficial venous system is basically different from the deep venous system. The superficial veins run independently from the arteries, they lie on the fascia and are partly separated from the subcutaneous connective tissue by their own fascia. This applies particularly to the great saphenous vein and the small saphenous vein. The great saphenous vein opens into the communicating femoral vein in the region of the saphenous opening of the fascia lata. The small saphenous vein continues into the thigh as the femoro-popliteal vein and finally opens into the great saphenous vein as the posterior accessory saphenous vein. The region of the opening into the great saphenous vein has many valves and side branches the most important of which are an ostial valve which is only sometimes present and the terminal valve. The latter is situated between the actual junction and the most proximal side branch. Even this is not constant and is found in only four out of five cases.     

下肢股腘静脉瓣功能的观察

目的:观察下肢股帼静脉瓣的功能.方法:30例下肢深静脉功能良好的单纯性大隐静脉曲张患者,经腘静脉穿刺下肢深静脉造影、透视下观察股腘静脉瓣的活动.结果:当病人作Valsalva运动(吸气后屏气)时,股腘静脉瓣均发生关闭;当病人作足屈伸运动时.股静脉瓣发生半开放、半关闭活动,但腘静脉瓣发生完全关闭和开放活动.结论:腘静脉瓣主要功能是参与小腿肌肉泵的活动,股静脉瓣的主要功能是抗逆向压力.     

Errors in the differential diagnosis of incompetence of the popliteal vein and short saphenous vein by Doppler ultrasound

Doppler Ultrasound is now routinely used to demonstrate valvular reflux in the venous system. Incompetence detected at the back of the knee is located either in the short saphenous vein or in the popliteal vein. Whether the incompetence is in the deep or superficial venous system can be differentiated by digital compression over the short saphenous vein in the upper calf; if reflux is abolished then the incompetence is assumed to be in the superficial vein but if it is not prevented it must be in the popliteal vein. Sometimes the reflux is not controlled when the deep system is normal. This has been shown to be due to variations in the anatomy of the short saphenous vein and especially the pattern of its termination. Examples with venography are given, showing that in the presence of incompetence at the sapheno-popliteal junction there may be no reflux in the short saphenous vein; instead the proximal tributaries are involved and reflux in these veins is not controlled by pressure over the short saphenous vein. This explains the false positive diagnosis of valvular incompetence in the popliteal vein.     

Histological comparison of autogenous canine fascia lata, Gore-Tex, lyophilized human fascia lata, and autogenous canine vein for vascular patch graft material in a canine arteriotomy model.

Autogenous fascia lata has found little clinical use as a vascular patch graft material. Previous experience, however, suggests that it possesses attributes that might make it useful in this regard. To assess its efficacy as a vascular patch graft, nine adult mongrel dogs each underwent four arteriotomies with placements of patch grafts. The four sites included both carotid arteries and both femoral arteries. In each animal, one of four patch graft materials (autogenous canine fascia lata, Gore-Tex, lyophilized human fascia lata, and autogenous canine vein) were placed as patch material at the arteriotomy site utilizing 7-0 running sutures and loop magnification. The site for placement of each graft material was rotated serially in the animals so that each site would have equal numbers of all four graft materials applied. The animals were killed at either 6 to 8 weeks or 11 to 12 weeks after angiography of all four vessels. The specimens were then evaluated histologically. No difference was observed among any of the patch graft materials with regard to myofibroblast plaque formation. Inflammatory responses were noted to be substantially less in the canine fascia lata group than in the other three groups. Granuloma formation, however, appeared to be most significant in the autogenous canine vein group. Only one vessel was occluded. Aneurysm or pseudoaneurysm formation was not noted in any specimen. It appears from the above results that autogenous fascia lata may be an appropriate alternative to currently utilized arterial patch graft materials and that it should be evaluated further for this purpose.     

Chronic venous insufficiency disease. Its etiology. A new technique for vein valve transplantation

This is a two-year study of 25 patients with venous insufficiency who were found to be in the terminal stage, referred to in this paper as chronic venous insufficiency disease (CVID). Apart from the usual signs and symptoms of venous insufficiency, the patients were found to have severe pain on weight bearing, inability to ambulate, and nonhealing lower extremity ulcers as common features that did not respond to conservative management. The most common underlying etiology was valvular incompetency. In the surgical management of these patients, at present, all the procedures described in the literature are primarily performed in the femoral veins of the groin or above the knee. A new technique is described in this paper that enables one to transplant vein valve segments to distal popliteal vein below the knee. There was a six- to twenty-four-month follow-up. Patients were periodically followed up with venography, venous pressure measurements, and venous reflux studies.